Erythematous and Vascular Oral Mucosal Lesions: A Clinicopathologic Review of Red Entities

Abstract

Erythematous lesions of the oral mucosa are common and can reflect a variety of conditions, ranging from benign reactive or immunologically-mediated disorders to malignant disease. Together with vascular abnormalities, which can vary from reddish to bluish-purple in color, the differential diagnosis for erythematous oral mucosal change is quite diverse. This review focuses on salient clinical features and histopathologic findings of selected conditions which clinically present as red or vascular-like oral mucosal alterations, including oral vascular malformations and neoplasms, pyogenic granuloma, localized juvenile spongiotic gingival hyperplasia, denture stomatitis, benign migratory glossitis (geographic tongue), orofacial granulomatosis, granulomatosis with polyangiitis (Wegener granulomatosis), megaloblastic anemia, and erythroplakia. Recognition of the characteristic clinical features of these conditions, in conjunction with thorough patient history, will allow clinicians to narrow the differential diagnosis and guide appropriate clinical decision making, including the need for tissue biopsy, in order to complete the diagnostic process and initiate optimal patient care.

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References

  1. 1.

    Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 1982;69(3):412–22.

    PubMed  CAS  Article  Google Scholar 

  2. 2.

    ISSVA Classification of Vascular Anomalies. ©2018 International Society for the Study of Vascular Anomalies Available at “issva.org/classification” Accessed 12 Oct 2018.

  3. 3.

    Garzon MC, Huang JT, Enjolras O, Frieden IJ. Vascular malformations: Part I. J Am Acad Dermatol. 2007;56(3):353. quiz 371–4.

    PubMed  Article  Google Scholar 

  4. 4.

    Fowell C, Verea Linares C, Jones R, Nishikawa H, Monaghan A. Venous malformations of the head and neck: current concepts in management. Br J Oral Maxillofac Surg. 2017;55(1):3–9.

    PubMed  CAS  Article  Google Scholar 

  5. 5.

    Love Z, Hsu DP. Low-flow vascular malformations of the head and neck: clinicopathology and image guided therapy. J Neurointerv Surg. 2012;4(6):414–25.

    PubMed  Article  Google Scholar 

  6. 6.

    Saravana GH. Oral pyogenic granuloma: a review of 137 cases. Br J Oral Maxillofac Surg. 2009;47(4):318–9.

    PubMed  CAS  Article  Google Scholar 

  7. 7.

    Al-Khateeb T, Ababneh K. Oral pyogenic granuloma in Jordanians: a retrospective analysis of 108 cases. J Oral Maxillofac Surg. 2003;61(11):1285–8.

    PubMed  Article  Google Scholar 

  8. 8.

    Chi AC, Weathers DR, Folpe AL, Dunlap DT, Rasenberger K, Neville BW. Epithelioid hemangioendothelioma of the oral cavity: report of two cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(6):717–24.

    PubMed  Article  Google Scholar 

  9. 9.

    Heera R, Cherian LM, Lav R, Ravikumar V. Hemangioendothelioma of palate: A case report with review of literature. J Oral Maxillofac Pathol. 2017;21(3):415–20.

    PubMed  PubMed Central  CAS  Article  Google Scholar 

  10. 10.

    Agaimy A, Mueller SK, Harrer T, Bauer S, Thompson LDR. Head and neck kaposi sarcoma: clinicopathological analysis of 11 cases. Head Neck Pathol. 2018;5:1–6

    Google Scholar 

  11. 11.

    Fanburg-Smith JC, Furlong MA, Childers EL. Oral and salivary gland angiosarcoma: a clinicopathologic study of 29 cases. Mod Pathol. 2003;16(3):263–71.

    PubMed  Article  Google Scholar 

  12. 12.

    Nagata M, Yoshitake Y, Nakayama H, Yoshida R, Kawahara K, Nakagawa Y, et al. Angiosarcoma of the oral cavity: a clinicopathological study and a review of the literature. Int J Oral Maxillofac Surg. 2014;43(8):917–23.

    PubMed  CAS  Article  Google Scholar 

  13. 13.

    Ordonez NG. Immunohistochemical endothelial markers: a review. Adv Anat Pathol. 2012;19(5):281–95.

    PubMed  CAS  Article  Google Scholar 

  14. 14.

    Lazos JP, Piemonte ED, Panico RL. Oral varix: a review. Gerodontology. 2015;32(2):82–9.

    PubMed  Article  Google Scholar 

  15. 15.

    Epivatianos A, Antoniades D, Zaraboukas T, Zairi E, Poulopoulos A, Kiziridou A, et al. Pyogenic granuloma of the oral cavity: comparative study of its clinicopathological and immunohistochemical features. Pathol Int. 2005;55(7):391–7.

    PubMed  Article  Google Scholar 

  16. 16.

    Gordon-Nunez MA, de Vasconcelos Carvalho M, Benevenuto TG, Lopes MF, Silva LM, Galvao HC. Oral pyogenic granuloma: a retrospective analysis of 293 cases in a Brazilian population. J Oral Maxillofac Surg. 2010;68(9):2185–8.

    PubMed  Article  Google Scholar 

  17. 17.

    Toida M, Hasegawa T, Watanabe F, Kato K, Makita H, Fujitsuka H, et al. Lobular capillary hemangioma of the oral mucosa: clinicopathological study of 43 cases with a special reference to immunohistochemical characterization of the vascular elements. Pathol Int. 2003;53(1):1–7.

    PubMed  Article  Google Scholar 

  18. 18.

    Brieley DJ, Crane H, Hunter KD. Lumps and bumps of the gingiva: a pathological miscellany. Head Neck Pathol. (pending).

  19. 19.

    Darling MR, Daley TD, Wilson A, Wysocki GP. Juvenile spongiotic gingivitis. J Periodontol. 2007;78(7):1235–40.

    PubMed  Article  Google Scholar 

  20. 20.

    Allon I, Lammert KM, Iwase R, Spears R, Wright JM, Naidu A. Localized juvenile spongiotic gingival hyperplasia possibly originates from the junctional gingival epithelium-an immunohistochemical study. Histopathology. 2016;68(4):549–55.

    PubMed  Article  Google Scholar 

  21. 21.

    Chang JY, Kessler HP, Wright JM. Localized juvenile spongiotic gingival hyperplasia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(3):411–8.

    PubMed  Article  Google Scholar 

  22. 22.

    Siamantas I, Kalogirou EM, Tosios KI, Fourmousis I, Sklavounou A. Spongiotic gingival hyperplasia synchronously involving multiple sites: case report and review of the literature. Head Neck Pathol. 2018;6:1–5

    Google Scholar 

  23. 23.

    de Freitas Silva BS, Silva Sant’Ana SS, Watanabe S, Vencio EF, Roriz VM, Yamamoto-Silva FP. Multifocal red bands of the marginal gingiva. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119(1):3–7.

    PubMed  Article  Google Scholar 

  24. 24.

    Gendreau L, Loewy ZG. Epidemiology and etiology of denture stomatitis. J Prosthodont. 2011;20(4):251–60.

    PubMed  Article  Google Scholar 

  25. 25.

    Barbeau J, Seguin J, Goulet JP, de Koninck L, Avon SL, Lalonde B, et al. Reassessing the presence of Candida albicans in denture-related stomatitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(1):51–9.

    PubMed  Article  Google Scholar 

  26. 26.

    Aoun G, Cassia A. Evaluation of denture-related factors predisposing to denture stomatitis in a lebanese population. Mater Sociomed. 2016;28(5):392–6.

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Nanetti A, Stancari F, Ferri M, Mazzoni A. Relationship between Candida albicans and denture stomatitis: a clinical and microbiological study. New Microbiol. 1993;16(3):287–91.

    PubMed  CAS  Google Scholar 

  28. 28.

    Hellstein JW. Candidiasis: diagnosis and management. Head Neck Pathol. (pending).

  29. 29.

    Bergendal T, Isacsson G. A combined clinical, mycological and histological study of denture stomatitis. Acta Odontol Scand. 1983;41(1):33–44.

    PubMed  CAS  Article  Google Scholar 

  30. 30.

    Gual-Vaques P, Jane-Salas E, Egido-Moreno S, Ayuso-Montero R, Mari-Roig A, Lopez-Lopez J. Inflammatory papillary hyperplasia: A systematic review. Med Oral Patol Oral Cir Bucal. 2017;22(1):e36–42.

    PubMed  CAS  Google Scholar 

  31. 31.

    Thwaites MS, Jeter TE, Ajagbe O. Inflammatory papillary hyperplasia: review of literature and case report involving a 10-year-old child. Quintessence Int. 1990;21(2):133–8.

    PubMed  CAS  Google Scholar 

  32. 32.

    Gual-Vaques P, Jane-Salas E, Mari-Roig A, Lopez-Lopez J. Inflammatory Papillary Hyperplasia in a Non-Denture-Wearing Patient: A Case History Report. Int J Prosthodont. 2017;30(1):80–2.

    PubMed  Article  Google Scholar 

  33. 33.

    Miloglu O, Goregen M, Akgul HM, Acemoglu H. The prevalence and risk factors associated with benign migratory glossitis lesions in 7619 Turkish dental outpatients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107(2):e29-33.

    PubMed  Article  Google Scholar 

  34. 34.

    Shulman JD, Carpenter WM. Prevalence and risk factors associated with geographic tongue among US adults. Oral Dis. 2006;12(4):381–6.

    PubMed  CAS  Article  Google Scholar 

  35. 35.

    Yesudian PD, Chalmers RJ, Warren RB, Griffiths CE. In search of oral psoriasis. Arch Dermatol Res. 2012;304(1):1–5.

    PubMed  CAS  Article  Google Scholar 

  36. 36.

    Fatahzadeh M, Schwartz RA. Oral psoriasis: an overlooked enigma. Dermatology. 2016;232(3):319–25.

    PubMed  Article  Google Scholar 

  37. 37.

    Picciani BL, Domingos TA, Teixeira-Souza T, Santos Vde C, Gonzaga HF, Cardoso-Oliveira J, et al. Geographic tongue and psoriasis: clinical, histopathological, immunohistochemical and genetic correlation—a literature review. An Bras Dermatol. 2016;91(4):410–21.

    PubMed  PubMed Central  Article  Google Scholar 

  38. 38.

    Lo Russo L, Fierro G, Guiglia R, Compilato D, Testa NF, Lo Muzio L, et al. Epidemiology of desquamative gingivitis: evaluation of 125 patients and review of the literature. Int J Dermatol. 2009;48(10):1049–52.

    PubMed  Article  Google Scholar 

  39. 39.

    Suresh L, Neiders ME. Definitive and differential diagnosis of desquamative gingivitis through direct immunofluorescence studies. J Periodontol. 2012;83(10):1270–8.

    PubMed  Article  Google Scholar 

  40. 40.

    Fitzpatrick SG, Cohen D, Clark A. Ulcerated lesions of the oral mucosa: clinical and histologic review. Head Neck Pathol. (pending).

  41. 41.

    Al-Hamad A, Porter S, Fedele S. Orofacial granulomatosis. Dermatol Clin. 2015;33(3):433–46.

    PubMed  CAS  Article  Google Scholar 

  42. 42.

    Grave B, McCullough M, Wiesenfeld D. Orofacial granulomatosis—a 20-year review. Oral Dis. 2009;15(1):46–51.

    PubMed  CAS  Article  Google Scholar 

  43. 43.

    Miest R, Bruce A, Rogers RS. Orofacial granulomatosis. Clin Dermatol. 2016;34(4):505–13.

    PubMed  Article  Google Scholar 

  44. 44.

    Saalman R, Mattsson U, Jontell M. Orofacial granulomatosis in childhood—a clinical entity that may indicate Crohn’s disease as well as food allergy. Acta Paediatr. 2009;98(7):1162–7.

    PubMed  Article  Google Scholar 

  45. 45.

    Campbell H, Escudier M, Patel P, Nunes C, Elliott TR, Barnard K, et al. Distinguishing orofacial granulomatosis from crohn’s disease: two separate disease entities? Inflamm Bowel Dis. 2011;17(10):2109–15.

    PubMed  Article  Google Scholar 

  46. 46.

    Lutalo PM, D’Cruz DP. Diagnosis and classification of granulomatosis with polyangiitis (aka Wegener’s granulomatosis). J Autoimmun. 2014;48–49:94–98.

    PubMed  Article  CAS  Google Scholar 

  47. 47.

    Stewart C, Cohen D, Bhattacharyya I, Scheitler L, Riley S, Calamia K, et al. Oral manifestations of Wegener’s granulomatosis: a report of three cases and a literature review. J Am Dent Assoc. 2007;138(3):338.

    PubMed  Article  Google Scholar 

  48. 48.

    Comarmond C, Cacoub P. Granulomatosis with polyangiitis (Wegener): clinical aspects and treatment. Autoimmun Rev. 2014;13(11):1121–5.

    PubMed  Article  Google Scholar 

  49. 49.

    Ruokonen H, Helve T, Arola J, Hietanen J, Lindqvist C, Hagstrom J. “Strawberry like” gingivitis being the first sign of Wegener’s granulomatosis. Eur J Intern Med. 2009;20(6):651–3.

    PubMed  Article  Google Scholar 

  50. 50.

    Nagao T, Hirokawa M. Diagnosis and treatment of macrocytic anemias in adults. J Gen Fam Med. 2017;18(5):200–4.

    PubMed  PubMed Central  Article  Google Scholar 

  51. 51.

    Drummond JF, White DK, Damm DD. Megaloblastic anemia with oral lesions: a consequence of gastric bypass surgery. Oral Surg Oral Med Oral Pathol. 1985;59(2):149–53.

    PubMed  CAS  Article  Google Scholar 

  52. 52.

    Greenberg MS. Clinical and histologic changes of the oral mucosa in pernicious anemia. Oral Surg Oral Med Oral Pathol. 1981;52(1):38–42.

    PubMed  CAS  Article  Google Scholar 

  53. 53.

    Triantafillidou K, Dimitrakopoulos J, Iordanidis F, Gkagkalis A. Extranodal non-hodgkin lymphomas of the oral cavity and maxillofacial region: a clinical study of 58 cases and review of the literature. J Oral Maxillofac Surg. 2012;70(12):2776–85.

    PubMed  Article  Google Scholar 

  54. 54.

    Epstein JB, Epstein JD, Le ND, Gorsky M. Characteristics of oral and paraoral malignant lymphoma: a population-based review of 361 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(5):519–25.

    PubMed  CAS  Article  Google Scholar 

  55. 55.

    Chowdhri K, Tandon S, Lamba AK, Faraz F. Leukemic gingival enlargement: A case report and review of literature. J Oral Maxillofac Pathol. 2018;22(Suppl 1):77–81.

    Article  Google Scholar 

  56. 56.

    Siegel RL, Miller KD, Jemal A. Cancer statistics. CA Cancer J Clin. 2018;68(1):7–30.

    PubMed  PubMed Central  Article  Google Scholar 

  57. 57.

    Lingen MW, Xiao W, Schmitt A, Jiang B, Pickard R, Kreinbrink P, et al. Low etiologic fraction for high-risk human papillomavirus in oral cavity squamous cell carcinomas. Oral Oncol. 2013;49(1):1–8.

    PubMed  Article  Google Scholar 

  58. 58.

    Poling JS, Ma XJ, Bui S, Luo Y, Li R, Koch WM, et al. Human papillomavirus (HPV) status of non-tobacco related squamous cell carcinomas of the lateral tongue. Oral Oncol. 2014;50(4):306–10.

    PubMed  PubMed Central  CAS  Article  Google Scholar 

  59. 59.

    Shafer WG, Waldron CA. Erythroplakia of the oral cavity. Cancer. 1975;36(3):1021–8.

    PubMed  CAS  Article  Google Scholar 

  60. 60.

    Reichart PA, Philipsen HP. Oral erythroplakia—a review. Oral Oncol. 2005;41(6):551–61.

    PubMed  Article  Google Scholar 

  61. 61.

    Moore C, Catlin D. Anatomic origins and locations of oral cancer. Am J Surg. 1967;114(4):510–3.

    PubMed  CAS  Article  Google Scholar 

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Correspondence to Kristin K. McNamara.

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McNamara, K.K., Kalmar, J.R. Erythematous and Vascular Oral Mucosal Lesions: A Clinicopathologic Review of Red Entities. Head and Neck Pathol 13, 4–15 (2019). https://doi.org/10.1007/s12105-019-01002-8

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Keywords

  • Erythematous
  • Erythema
  • Red
  • Vascular
  • Oral mucosa
  • Diagnosis